Mental Health Concept
1. Health Assessment: Assessing Mental Status; pages 732-734 (Fundamentals of Nursing)
o Assessment includes: level of consciousness, level of awareness, behavior and appearance, memory, and language.
2. Antidepressant Agents; pages 351-368 (Pharmacology)
o Drugs List
o...
o Other Antidepressants
▪ bupropion
▪ desvenlafaxine
▪ duloxetine
▪ levomilnacipran
▪ milnacipran
▪ mirtazapine
▪ nefazodone
▪ selegiline
▪ trazodone
▪ venlafaxine
o Tricyclic Antidepressants KEY POINTS
▪ Affect is a term that refers to the feelings that people experience when they respond emotionally.
▪ Depression is an affective disorder characterized by inappropriate sadness, despair, and hopelessness.
▪ According to the biogenic amine theory, depression is caused by a brain deficiency of the biogenic
amines. Antidepressant drugs are thought to raise the level of the biogenic amines.
o Monoamine Oxidase Inhibitors Key points
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W.H. Health Readings
▪ EXAM 1 of NE and 5HT by MAO, leading to an increased level of these biogenic
The MAOIs prevent the breakdown
amines in the synaptic cleft. This accumulation of the amines is thought to relieve the signs and symptoms
of depression.
▪ Patients taking MAOIs need to avoid foods high in tyramine to prevent serious increases in blood
pressure and hypertensive crises.
o Selective Serotonin Reuptake Inhibitors key points
▪ The SSRIs prevent the reuptake of serotonin into the presynaptic nerve, leading to an accumulation
of these biogenic amines in the synaptic cleft. This accumulation causes increased stimulation of the
postsynaptic nerve and may be responsible for the antidepressant effects of these drugs.
▪ The SSRIs are not associated with many of the CNS, CV, and anticholinergic effects of
other antidepressants.
▪ Combination of SSRIs with other SSRIs or with other drugs that are known to increase 5HT levels
increase the risk of serotonin syndrome.
▪ Increased bleeding is possible with these drugs since they affect 5HT, a key component in platelet activity.
Caution should be used if any of these drugs is combined with other drugs known to affect bleeding
o Chapter Summery
▪ Depression is a very common affective disorder; it is associated with many physical manifestations and
is often misdiagnosed. It could be that depression is caused by a series of events that are not yet
understood.
▪ Antidepressant drugs—TCAs, MAOIs, and SSRIs—increase the concentrations of the biogenic amines in
the brain.
▪ Selection of an antidepressant depends on individual drug response and tolerance of associated adverse
effects. The adverse effects of TCAs are sedating and anticholinergic; those of MAOIs are CNS related
and sympathomimetic. The adverse effects of SSRIs are fewer, but they do cause CNS changes.
▪ Other antidepressants with unknown mechanisms of action are also effective in treating depression.
▪ All of these drugs have a black box warning of the risk of suicidality, particularly in children,
adolescents, and young adults.
3. Psychotherapeutic Agents; pages 369-387 (Pharmacology)
o Drug List Antipsychotic/Neuroleptic Drugs
▪ Typical Antipsychotics
• chlorpromazine
• fluphenazine
• haloperidol
• loxapine
• perphenazine
• pimozide
• prochlorperazine
• thioridazine
• thiothixene
• trifluoperazine
▪ Atypical Antipsychotics
• aripiprazole
• asenapine
• clozapine
• iloperidone
• lurasidone
• olanzapine
• paliperidone
• quetiapine
• risperidone
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W.H. Health Readings
• ziprasidone EXAM 1
▪ Central Nervous System Stimulants
• armodafinil
• atomoxetine
• dexmethylphenidate
• dextroamphetamine
• guanfacine
• lisdexamfetamine
• methylphenidate
• modafinil
o Schizophrenia, the most common type of psychosis, can be very debilitating and prevents affected individuals from
functioning in society. Characteristics of schizophrenia include hallucinations, paranoia, delusions, speech
abnormalities, and affective problems. This disorder, which seems to have a very strong genetic association, may
reflect a fundamental biochemical abnormality.
o Bipolar disorder involves extremes of depression alternating with hyperactivity and excitement. This condition
may reflect a biochemical imbalance followed by overcompensation on the part of neurons and their inability to
reestablish stability.
o Narcolepsy is characterized by daytime sleepiness and sudden periods of loss of wakefulness. This disorder may
reflect problems with stimulation of the brain by the reticular activating system (RAS) or problems with response
to that stimulation.
o Attention deficit disorders involve various conditions characterized by an inability to concentrate on one activity
for longer than a few minutes and a state of hyperkinesis. These conditions are usually diagnosed in school-aged
children but can occur in adults.
o Antipsychotic/Neuroleptic drugs KEY POINTS
▪ Mental disorders are thought process disorders that may be caused by some inherent dysfunction within
the brain. A psychosis is a thought disorder, and schizophrenia is the most common psychosis in which
delusions and hallucinations are hallmarks.
▪ Antipsychotic drugs are generally dopamine receptor blockers that are effective in helping people
to organize thought patterns and to respond appropriately to stimuli.
▪ Antipsychotics can cause hypotension, anticholinergic effects, sedation, and extrapyramidal
effects, including parkinsonism, ataxia, and tremors.
o Drugs for bipolar disorder KEY POINTS
▪ Lithium, a membrane stabilizer, is the standard antimanic drug. Because it is a very toxic salt, serum
levels must be carefully monitored to prevent severe toxicity.
▪ Many other CNS drugs, including many of the atypical antipsychotics, are now approved for use in
bipolar disorder. Many patients respond to a combination of these drugs to control their bipolar signs
and symptoms.
o Central nervous system stimulants ket points
▪ An attention deficit disorder is a behavioral syndrome characterized by hyperactivity and a short
attention span.
▪ Narcolepsy is a disorder characterized by daytime sleepiness and sudden loss of wakefulness.
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W.H. Health Readings
▪ EXAMcortical
CNS stimulants, which stimulate 1 levels and the RAS to increase RAS activity, are used to treat
attention deficit disorders and narcolepsy. These drugs improve concentration and the ability to filter and
focus incoming stimuli.
o Chapter summery
▪ Schizophrenia, the most common psychosis, is characterized by delusions, hallucinations,
and inappropriate responses to stimuli.
▪ Bipolar disorder is a behavioral disorder that involves extremes of depression alternating
with hyperactivity and excitement.
▪ An attention deficit disorder is a behavioral syndrome characterized by hyperactivity and a short
attention span.
▪ Narcolepsy is a disorder characterized by daytime sleepiness and sudden loss of wakefulness.
▪ Lithium, a membrane stabilizer, is the standard antimanic drug. Because it is a very toxic salt, serum levels
must be carefully monitored to prevent severe toxicity. Many other CNS drugs are now approved for use in
bipolar disorder.
▪ CNS stimulants, which stimulate cortical levels and the RAS to increase RAS activity, are used to treat
attention deficit disorders and narcolepsy. These drugs improve concentration and the ability to filter
and
focus incoming stimuli.
Abuse/Neglect
1. Conception Through Young Adult: Child Maltreatment (including Table 22-2); page 535 (Fundamentals of Nursing)
a. “Any recent act or failure to act on the part of a parent or caretaker which results in death, serious physical or
emotional harm, sexual abuse or exploitation; or an act or failure to act which presents an imminent risk of
serious harm”
b. Most cases are from birth to 4 years of age
c. Childhood abuse and neglect have a long term consequence for health.
d. Risk factors for abuse and neglect
i. Caregivers’ substance abuse; this includes manufacturing, distribution or selling, using, and
prenatal exposure
ii. Caregivers experiencing stress from poverty or unemployment
iii. Caregivers’ mental illness or other health problems
iv. History of violence in the family or community
v. Physical or mental disabilities in the child or children that may increase caregiver burden
vi. Caregivers’ lack of knowledge about parenting and the normal behaviors and development of children
vii. Lack of family and social support for caregivers, social isolation of families, lack of family cohesion,
single caregiver, young caregivers
2. Sexuality: Counseling in Cases of Abusive Relationships and Rape; pages 1780-1781 (Fundamentals of Nursing)
a. Sexual violence is NOT about love or sex; it is about power, violence, and control.
b. Victims of sexual assault are 3 times more likely to suffer from depression, 6 times more likely to suffer from
posttraumatic stress disorder, 13 times more likely to abuse alcohol, 26 times more likely to abuse drugs, and
4 times more likely to contemplate suicide.
3. Assessment and Management of Patients With Female Physiologic Process: Assessment/Health History: Intimate
Partner Violence; page 1657 (Medical-Surgical Nursing)
a. IPV involves four main types of violence: physical, sexual, stalking, and psychological aggression.
b. It is rarely a onetime occurrence.
c. Manifestations of abuse, maltreatment, and neglect may involve suicide attempts, drug and alcohol abuse,
frequent emergency department visits, vague pelvic pain, somatic complaints, and depression. However, there
may be no obvious signs or symptoms.
4. Assessment and Management of Patients With Female Physiologic Process: Assessment Health History: Incest
and Childhood Sexual Abuse; pages 1657-1658 (Medical-Surgical Nursing)
a. Women who have experienced rape or sexual abuse may be very anxious about pelvic examinations, labor, pelvic
or breast irradiation, or any treatment or examination that involves hands-on treatment or requires removal of
clothing. Nurses should be prepared to offer support and referral to psychologists, community resources, and
self- help groups.
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